Monthly Archives: April 2008

We are excited to be offering Wavefront guided treatments at Western Laser Eye Associates using Calgary’s newest laser.

In Calgary LASIK remains the most common laser vision correction performed, but photorefractive keratectomy (PRK) is making a come back. As reported on CNN today, PRK is becoming a more popular choice for many patients and surgeons in recent years due to it’s safety and effectiveness. The CNN article outlines a number of alternatives to LASIK.

Dr. Anderson Penno has been a long time advocate of PRK and is pleased to offer advanced surface ablation with PRK. With the new technology available on the Visx S4 IR excimer laser and WaveScan WaveFront mapping system, an individualized map can be used to treat fine variations in addition to the overall correction for nearsightedness, farsightedness, and astigmatism. While PRK requires about a week before return to work, it is an excellent alternative to LASIK and may add a measure of safety for many patients.

It is important to understand your options and to have a thorough discussion with your surgeon before deciding which surgery may be best for you.

4/25/08 Physicians testified Friday on behalf of the American Academy of Opthalmology (AAO) as part of the US FDA ongoing study on LASIK satisfaction. They presented information from studies that involved thousands of LASIK patients over the past 15 years. Over 16,000 eyes have been studied since 1993. For the majority of patients the outcome of LASIK is excellent and poor outcomes are rare. The goal of this study is to understand how patient satisfaction can be improved even further.

The AAO supports the FDA’s planned prospective study on quality of life following LASIK surgery. Over 15 million people worldwide have had LASIK, and in the past several years technology has improved. The prospective study will give a better understanding of the factors which contribute to dissatisfaction following LASIK.

There are alternatives to LASIK. For many patients PRK may be a safer alternative to LASIK. With PRK there is no corneal flap so the complications are lower at the time of surgery, and there is less risk with future eye injuries as there is no flap that can get damaged or dislodged. PRK does require approximately one week for recovery before return to work. For patients over 55 years old, refractive lensectomy may be an alternate option. All of these options should be discussed with the refractive surgeon before making a final decision about which procedure is best for you.

April 24, 2008 CNN reported on the FDA study that will follow hundreds of LASIK patients to find out why while the majority of patients are satisfied there is a small percentage of patients with significant side effects such as dry eye, night vision complaints or blurred vision. While some side effects like dry eye may be only temporary in most patients after LASIK, the FDA advises potential patients to carefully read the information provided by their surgeon to make an informed choice about whether to have surgery.

CNN quoted Dr. Steven Shallhorn from the US Navy’s refractive surgery program who pointed out that there have been refinements to LASIK in recent years that may offer crisper vision. One of those refinements has been the development of wavefront guided corrections which is available on lasers such as the Visx S4 IR.

Some of the 25% of people wishing to have LASIK are not good candidates, but for some of them Photorefractive keratectomy (PRK) may be a good alternative. PRK may be a safer procedure because it does not require a flap and does not affect the corneal tissue as deeply, but there is more discomfort in the first few days and recovery make take up to a week. For many patients the added safety may be worth the time needed for recovery. It is important for anyone considering LASIK or PRK to read all the materials provided at the pre-operative evaluation and to discuss any questions with their surgeon before surgery. Most people who undergo laser vision correction are satisfied with their results.

Ophthalmology Times reported in the March 1, 2008 edition that women physicians are at an all time high. This trend is predicted to increase in the future. In 2004 the American Medical Association (AMA) reported that 25% of practicing physicians were women. They predict that by 2010 thirty percent of practicing physicians will be women.

This trend is even more apparent in certain subspecialities such as ophthalmology and obstetrics. The American Academy of Ophthalmology (AAO) reported in 1994 that women accounted for 25% of trainees in ophthalmology. By 2004 that number climbed to 34% of the members in training. The prediction is that by 2025 the number of men and women on medical school faculties will be equal.

While high volume women LASIK surgeons remain a minority in Alberta, this is likely to change in the next several years as more women complete ophthalmology residencies and refractive surgery fellowships. While women remain a minority in executive positions and academic medicine, this is predicted to change as well in the coming years.

It has been well known by laser eye surgeons that the eyes of some patients will undergo clyclotorsion, also known as cyclorotation, when laying flat for laser vision correction.

This means that in some patients the measurements taken with the patient sitting up may be misaligned with respect to rotational axis when laying flat for LASIK or PRK. This is of particular importance for patients with higher astigmatism who need an accurate treatment on the correct axis and for those undergoing custom wavefront ablation in which the patient’s individual abberations are measured and then corrected with the laser.

A recent article in the Journal of Cataract and Refractive Surgery (Kim H, Joo CK. 1: J Cataract Refract Surg. 2008 Apr;34(4):557-61) studied cyclorotation with the iris registration features on the Visx WaveScan Wavefront system with the patient seated and the Visx Star S4 Laser with the patient laying flat as they would for laser eye surgery. They found that 13% of eyes tested had cyclorotation of greater than 5 degrees. This amount of cyclorotation could affect outcomes of astigmatism and custom wavefront laser eye treatments.

In the past some surgeons have used an eye marking technique to compensate for cyclorotation for patients with high astigmatism. With this technique a small ink mark is made on the cornea and then the surgeon will rotate the patient’s head to compensate. Other factors such as head tilting or patient position on the bed can cause the eye to be rotated with respect to the laser treatment even if there is no actual cyclorotation of the eye.

Western Laser Eye Associates is pleased to offer the iris recognition feature with cyclorotation control to our LASIK and PRK patients who are candidates for custom WaveScan treatments.

The American Academy of Ophthalmology (AAO) Ophthalmic News & Education (O.N.E.) network (www.one.aao.org) recently reported the results of nearly 3,000 peer-reviewed articles published over that past 10 years.

Kerry Solomon MD of the Storm Eye Institute of the Medical Center of South Carolina led the study which found that 95.4 percent of LASIK patients worldwide were satisfied the their procedure. The report also found that the majority of those who had LASIK would recommend LASIK to a friend.

As the authors of the meta-analysis point out, this report confirms the success that laser eye surgeons in Canada and worldwide have been reporting from their experience treating patients over the past decade.

Recently the FDA noted that while there are no published studies to suggest significant problems with quality of life following LASIK, there have been few well designed studies to evaluate quality of life post-LASIK.

In response to consumer concerns, the FDA is undertaking a joint task force to try and quantify the small percentage of patients that were dissatisfied with LASIK.

The task force includes assistance from the National Eye Institute of the National Institutes for Health, the American Society of Cataract and Refractive Surgeons (ASCRS), and the American Academy of Ophthalmology (AAO). Refractive surgeons across the United States will participate in this large clinical study to investigate patient satisfaction following LASIK. The AAO reports that a meta-analysis of the worldwide literature about patient satisfaction following LASIK is underway. Additional information about laser eye surgery can be found on our website www.westernlasereye.com as well as the AAO website www.aao.org and the FDA website at www.fda.gov .

Refractive surgeons look forward to the results of this study as it will help in counseling patients before surgery, and help patients to make the best choices for vision correction.